# Identifying and Addressing Opportunities in Primary Care to Improve Healthy Birth Intervals

> **NIH NIH R21** · UNIVERSITY OF CHICAGO · 2022 · $203,118

## Abstract

ABSTRACT
Approximately 30% of pregnancies in the United States occur after a short interpregnancy interval (IPI) <18
months. Short IPI is associated with adverse maternal and infant outcomes, especially among women from
high-risk populations. Primary care offers an opportunity to engage and educate reproductive age patients
about birth spacing, provide preconception and contraceptive care between pregnancies (“interconception”
care) and coordinate their acute and chronic care needs. Groups with higher risks of adverse pregnancy
outcomes, such as low-income women, are more likely to receive their reproductive care from a primary care
provider (PCP) than an obstetrician-gynecologist. Three quarters of reproductive age women in the United
States have at least one physician visit each year, most commonly with their PCP; however, only 14% of office
visits involve preconception or contraceptive care. Many PCPs already feel task-saturated when delivering
primary care and face numerous barriers to providing high-quality interconception care. Although some
interventions appear to be effective, attempts to improve preconception/interconception care, within primary
care, have had limited success. We hypothesize that this may be due to inadequate design for sustainable
implementation into clinical workflows. This developmental study will therefore gather key stakeholders (e.g.
primary care clinicians, nurses, practice administrators and staff) and female reproductive age patients at three
diverse primary practices to take part in a failure modes effects and criticality analysis (FMECA). This risk
assessment engineering methodology will allow us to fully characterize and understand the failures/missed
opportunities in the systems and processes of primary care to deliver interconception care. We will then apply
an iterative user-centered design approach, building from existing interventions and from the FMECA results,
to create a novel intervention for integrating effective, patient-centered interconception care into primary care.
In future work, we intend to test this novel intervention using a type II hybrid implementation/effectiveness trial.

## Key facts

- **NIH application ID:** 10471325
- **Project number:** 5R21HD104086-02
- **Recipient organization:** UNIVERSITY OF CHICAGO
- **Principal Investigator:** Debra Stulberg
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $203,118
- **Award type:** 5
- **Project period:** 2021-08-17 → 2023-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10471325

## Citation

> US National Institutes of Health, RePORTER application 10471325, Identifying and Addressing Opportunities in Primary Care to Improve Healthy Birth Intervals (5R21HD104086-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10471325. Licensed CC0.

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